Herlyn-Werner-Wunderlich syndrome, also referred to as obstructed hemivagina with ipsilateral renal agenesis (OHVIRA) is a rare congenital urogenital anomaly resulting from abnormal development of the Müllerian and Wolffian ducts, classically characterized by uterus didelphys, obstructed hemivagina, and ipsilateral renal agenesis. It typically presents after menarche with nonspecific symptoms, often leading to delayed diagnosis and increased risk of complications such as hematometra and pelvic endometriosis. Radiologic imaging plays a key role in early detection and prevention of disease progression. A 16-year-old female presented with progressive dysmenorrhea for 1.5 years and irregular menstruation. Ultrasonography demonstrated uterus didelphys, a left adnexal cyst suggestive of endometrioma, and left renal agenesis. Magnetic resonance imaging (MRI) further delineated a noncommunicating left uterine unit with cervicovaginal atresia and hematometra, consistent with type 1.2 HWWS. MRI also confirmed a left ovarian endometrioma, showing T1 hyperintensity and T2 shading. CT urography further confirmed complete left renal and ureteral agenesis with preserved contralateral renal excretory function, completing the radiologic evaluation of the associated urinary tract anomaly. These multimodality imaging findings established the diagnosis and accurately defined the extent of the congenital anomaly and its associated complications. This case emphasizes the importance of early recognition of Herlyn-Werner-Wunderlich syndrome in adolescents with persistent dysmenorrhea and underscores the pivotal role of imaging. While ultrasonography is useful for initial assessment, MRI remains the gold standard for comprehensive evaluation. Early and accurate diagnosis is essential to guide management and prevent long-term complications, including endometriosis and infertility.

Congenital abnormalities of the kidney and urinary tract (CAKUT) encompass diverse diagnoses that commonly present as urinary tract dilatation and are the leading cause of kidney failure in children. Antenatal hydronephrosis occurs in ~1% of pregnancies; most resolve spontaneously, but conditions such as posterior urethral valves (PUV), pelviureteric junction obstruction (PUJO), vesicoureteric junction obstruction (VUJO), duplex systems, ureteroceles, and vesicoureteric reflux (VUR) require specific approaches to diagnosis and management. Postnatal surveillance relies predominantly on renal tract ultrasound, with micturating cystourethrogram and nuclear scintigraphy used in specific scenarios to define diagnoses, confirm obstruction, and quantify differential function. Urinary tract infections (UTIs) are common and can cause significant morbidity, including sepsis and long-term scarring; prevention of febrile UTIs (fUTIs) is often a central goal. PUV is often associated with a high risk of kidney impairment and fUTI, with early diagnosis, bladder drainage, valve incision, circumcision, and antibiotic prophylaxis shown to reduce UTI risk. VUJO and duplex anomalies carry variable fUTI risk influenced by ureteric dilation and ureteroceles; endoscopic and surgical interventions are effective when indicated. Primary VUR management emphasises bladder-bowel dysfunction treatment, selective antibiotic prophylaxis, and endoscopic injection for recalcitrant fUTIs. Routine prophylaxis is not recommended for isolated unilateral hydronephrosis without distal ureteric dilatation. Management balances infection prevention, renal preservation, and functional outcomes.

Uterine prolapse is a common pathology and can be an insidious cause for hydronephrosis and end stage renal failure. We report a case of progressive chronic kidney disease, secondary to uterine prolapse. Her initial pelvic exam, cystoscopy and functional testing demonstrated no obvious aetiology of obstruction when she was tested in the supine position. Repeat testing in the erect position demonstrated a urinary tract obstruction as the cause for her progressive chronic kidney disease. This case highlights that there may be a role for erect functional imaging as an adjunct in the diagnostic pathway for dynamic extrinsic obstructive nephropathy, when exam and standard supine imaging are non-diagnostic. Timely and accurate diagnosis was associated with avoidance of dialysis initiation and with significant recovery of renal function.

Bladder calculi are an uncommon form of urolithiasis in developed countries and are usually associated with urinary stasis, bladder outlet obstruction, chronic catheterization, recurrent urinary tract infections, and neurogenic bladder dysfunction. Although their diagnosis is often straightforward, bladder multilithiasis may present across heterogeneous clinical scenarios, ranging from uncomplicated intravesical stones to advanced neglected disease with obstructive complications. Imaging may also be relevant for differential diagnosis when intravesical calcified lesions or bladder wall calcifications are considered. We present a retrospective multimodality imaging case series of 4 male patients (68-80 years) with bladder multilithiasis evaluated with ultrasound, radiography, computed tomography (CT), and magnetic resonance imaging (MRI). Three patients underwent ultrasound as the first-line examination, demonstrating multiple dependent echogenic intravesical foci with posterior acoustic shadowing. CT was particularly valuable in the most advanced case, where massive bladder multilithiasis was associated with severe bilateral hydronephrosis, hydroureter, delayed urinary excretion, renal cortical thinning, and perivesical inflammatory changes. MRI, although not routinely used for stone detection, provided useful incidental anatomical correlation by showing persistent intravesical signal voids across multiple sequences. This case series highlights that the radiologic relevance of bladder multilithiasis extends beyond simple stone detection. Ultrasound remains a first-line modality, whereas CT is essential for evaluating stone obstructive complications. MRI has no primary role in routine stone work-up but may provide complementary information in selected pelvic examinations. Familiarity with imaging patterns, complication signs, and differential diagnoses may improve diagnostic confidence and support appropriate management, particularly in elderly or vulnerable patients with delayed presentation.

Partial bladder outlet obstruction (pBOO) is a fibroproliferative disorder that results in poorly compliant, high-pressure bladders due to lower urinary tract occlusion. The mechanisms governing pBOO-induced bladder remodeling remain poorly understood. The goals of the present study were to profile global and region-specific transcriptomes of porcine bladders in response to pBOO using RNA sequencing and to identify genes and pathways differentially affected in the bladder dome and trigone by obstructive injury. Nine adult female Yucatan mini-swine were randomized and divided into either nonsurgical controls (n = 5) or those subjected to pBOO for 4 weeks (n = 4). Post-pBOO swine demonstrated bladder smooth muscle hypertrophy as well as significant declines in bladder capacity (35% ± 7% of baseline) and compliance (38% ± 10% of baseline). The global transcriptome of obstructed bladders revealed enrichment of processes related to loss of urothelial barrier function, immune activation, cell cycle regulation, extracellular matrix organization, and signal transduction similar to human and rodent evaluations of pBOO. Moreover, our data also showed that adaptive responses to pBOO are regionally dependent rather than globally uniform, with zonal-specific divergence observed across hypoxic, fibrotic, metabolic, and neuronal pathways between the obstructed dome and trigone. These results highlight the regional heterogeneity of bladder responses to obstructive urologic disease.

Hematuria and flank pain are a typical urology emergency, often presented as the primary complaint. However, in patients with previous aortolia surgery, these symptoms may rarely indicate external compression of the urinary tract by an anastomotic pseudoaneurysm. We herein describe an unusual case of a 50-year-old man who presented to the urologist with hematuria and right flank pain due to ureteric compression by an aortic anastomotic pseudoaneurysm. He had undergone an open aortolia revascularization procedure with a bifurcated graft 9 years earlier and the pseudoaneurysm was found at the proximal anastomosis pressurizing the right ureter. The patient was successfully treated with a pigtail placement and an endograft implantation resulting in resolution of his symptoms. Urological symptoms in patients with a history of previous aortolia surgery should raise the suspicion of an anastomotic pseudoaneurysm.